The Efficiency of Transarterial Chemoembolization with Drug-Eluting Beads in Hepatocellular Carcinoma

İlaç yüklü partiküllerle yapılan transarteriyel kemoembolizasyon (DEB-TAKE); inoperatif hepatosellüler karsinomun (HCC) paliyatif tedavisinde yeni bir seçenektir. Literatürde HCC’li hastaların tedavisinde DEB-TAKE’nin etkinliği hakkında sınırlı bilgi vardır. Bu çalışmanın amacı inoperatif HCC olgularında DEB-TAKE tedavisinin etkinliğini (sağkalım, tümör cevabı) ve güvenliliğini değerlendirmek; aynı zamanda bu hastalarda DEB-TAKE sonrası sağkalımda prognostik faktörleri belirlemektir. İnoperatif HCC’si olan, 40-86 yaş arası (ort. 67.04) 5’i kadın ,21’i erkek toplam 26 HCC olgusuna (18 Child-Pugh A ve 8 Child-Pugh B) doksorubisin yüklü partikülle kemoembolizasyon uygulandı. 20 hastaya tek, kalan 6 hastaya çift girişim uygulandı. Grupların 6. ve 12. ay ortanca sağkalım süreleri hesaplandı. DEB-TAKE’nin ilk uygulanmasını takiben olguların 6.ay ve 1 yıllık yaşam süreleri sırasıyla %80 ve %57 olarak saptandı. 1. ve 6.ayda objektif tümör yanıt oranları sırasıyla %46.2 ve %57.1 olarak bulundu. Child-Pugh evresi, Okuda evresi, Cancer of the Liver Italian Programme (CLIP) skoru, Barcelona Clinic Liver Cancer (BCLC) evresi, serum albumin seviyesi, Eastern Cooperative Oncology Group (ECOG) performans statüsü (PS), tümör morfolojisi ve hacmi DEB-TAKE sonrası sağkalımda prognostik faktörler olarak saptandı. Bütün girişimler teknik olarak başarıyla tamamlandı ve işleme bağlı majör komplikasyon görülmedi.Takiplerde 18 hasta öldü, 8 hasta yaşamaktadır. Çalışmamız sonucunda inoperatif HCC olgularında DEBTAKE’nin seçilmiş hasta gruplarında güvenli ve iyi tolere edilebilir bir yöntem olduğu sonucuna varılmıştır. Bununla birlikte tedavi etkinliğini değerlendirecek prospektif randomize kontrollü çalışmalara ihtiyaç vardır

Anahtar Kelimeler:

Hepatosellüler karsinom, ilaç yüklü partikül, transarteriyel kemoembolizasyon

The Efficiency of Transarterial Chemoembolization with Drug-Eluting Beads in Hepatocellular Carcinoma

Transarterial chemoembolization (TACE) with drug-eluting beads (DEB) is a new palliative treatment method for patients with hepatocellular carcinoma (HCC). Little is known about the efficiency of DEB-TACE for patients with HCC. The purpose of our study was to evaluate the treatment efficacy (survival rate, tumor response) and safety of DEB-TACE for inoperable HCC and to identify the predictors of survival in patients with unresectable HCC. Twenty-six patients (18 Child-Pugh A, 8 Child-Pugh B) underwent chemoembolization with doxorubicin DEB, including 5 women and 21 men with a mean age of 67.04 years (range 40–86 years). Twenty patients had one DEB-TACE procedure, while the remaining six had two procedures. Overall median survival and survival at 6 and 12 months were calculated. Meanwhile, the response rate was assessed using response evaluation criteria in solid tumors criteria on computed tomography/magnetic resonance imaging at 1 and 6 months. Overall survival rates at 6 months and 1 year from the first administration of doxorubicin DEB-TACE were 80% and 57%, respectively. At 1 and 6 months, objective tumor response rates were 46.2% and 57.1%, respectively. Child-Pugh class, Okuda staging, Cancer of the Liver Italian Programme score, Barcelona Clinic Liver Cancer staging, serum albumin level, Eastern Cooperative Oncology Group performance status, and tumor morphology and volume were found to be prognostic factors for survival. All of the procedures were technically successful, and there were no major complications. Eighteen patients died during the study period and eight survived.Transarterial chemoembolization with DEB is safe and well tolerated in patients with inoperable HCC. Additional prospective randomized controlled studies are required to assess the efficiency of DEB-TACE.

Keywords:

Hepatocellular carcinoma, drug-eluting beads, transarterial chemoembolization,

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